Advisory Committee on Maternal Fatalities and Morbidity (MFM) Meeting - - PDF document

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Advisory Committee on Maternal Fatalities and Morbidity (MFM) Meeting Time and Location: Thursday, October 17, 2019: 8:30AM-12:00PM Arizona Department of Health Services Building 250 N 17th Ave., Phoenix, AZ 250-IGLOO Conference Room (1st

SLIDE 1 Advisory Committee on Maternal Fatalities and Morbidity (MFM) Meeting Time and Location: Thursday, October 17, 2019: 8:30AM-12:00PM Arizona Department of Health Services Building 250 N 17th Ave., Phoenix, AZ 250-IGLOO Conference Room (1st Floor) Please join the meeting from your computer, tablet, or smartphone: Join Webex meeting ID: 805137610 Password: itjnQNVu Join by phone +1-415-655-0003 US Toll Access code: 805-137-610 Agenda items: I. Call to Order Committee Chair II. Review and Approval of Minutes Committee Chair

III. General Report Feedback

Facilitator

IV. Roundtable on Recommendations

Facilitator V. Additional Discussion on Methodology Facilitator

VI. Review Timeline and Next Steps

Facilitator

VII. Call to the Public

Committee Chair VIII.Meeting Adjourned Next Meeting Date: Thursday, November 14 at 8:30AM Call to the Public: This is the time for the public to comment. Members of the Board may not discuss items that are not specifically identified on the agenda. Therefore, pursuant to A.R.S. § 38-431.01(H), action taken as a result of public comment will be limited to directing staff to study the matter, responding to any criticism or scheduling the matter for further consideration and decision at a later date Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

SLIDE 2 Maternal Fatalities and Morbidity Advisory Committee Meeting Members Present: Patricia Tarango

Dr. Charlton Wilson
Dr. Michael Madsen

Amy Lebbon

Dr. Carl Bronitsky
Dr. Robert Johnson

Sandy Severson

Dr. Eric Tack

Mary Ellen Cunningham

Dr. Mike Foley

Breann Westmore Jennifer Carusetta Diana Jolles (via teleconference)

Dr. Cynthia Booth (via teleconference)
Dr. Guadalupe Herrera-Garcia (via

teleconference) Mike Mote (via teleconference) Members Absent:

Dr. Satya Sarma

ADHS Staff Present: Jessica Perfette, ADHS, BWCH Kate Lewandowski, ADHS, BWCH Gerilene Haskon, ADHS, BWCH Kyle Gardner, ADHS, BWCH Heidi Christensen, ADHS, BWCH Martín Celaya, ADHS, BWCH (via teleconference) Public Attendees Present: Dave Nakashima, Facilitator Jessie Armendt, MOD 1. Call to Order The Maternal Fatalities and Morbidity Advisory Committee meeting convened at the Arizona Department of Health Services, 150 N 18th Avenue, 540 A (5th Floor) in Phoenix, Arizona and via teleconference on Monday, September 16, 2019. Gerilene Haskon conducted roll call. A quorum being present, Madam Chair Patricia Tarango call the meeting to order at 12:06 PM. 2. Review and Approval Of Minutes Madam Chair Patricia Tarango introduced the meeting minutes from the Advisory Committee Meeting held on August 30,2019 for review. Ms. Mary Ellen Cunningham motioned to accept the minutes as written. Dr. Charlton Wilson seconded the motion and the advisory committee voted and approved. Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

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SLIDE 3 3. Review Gaps and Proposed Solutions Sheets Martín Celaya, Chief of Assessment and Evaluation in the Bureau of Women’s and Children’s Health at the Arizona Department of Health Services gave an overview of the identified challenges and possible solutions for the Maternal Mortality Review process. For more detailed information please refer to meeting handout titled, Maternal Mortality Review Process: Identified Challenges and Recommendations. 4. Panel Discussion with ADHS Staff Kyle Garder, Kate Lewandowski, Jessica Perfette, Gerilene Haskon, and Martín Celaya (via phone) were all present and available to answer questions from the Advisory Committee. Staff answered all the questions posed by the committee; however there was no formal panel discussion. The following are questions submitted prior to the meeting to be answered by the panel: 1. Could someone on the panel explain the MMRC’s four categories of deaths (pregnancy-related death; pregnancy-associated death; not pregnancy related or associated; and unable to determine) and how the determination is made in which category the death is categorized? 2. In the last report on maternal deaths, it was talked about how deaths that were flagged for being a pregnancy related death needed to be confirmed. Could someone discuss that process and what records are being reviewed? 3. On the Arizona death certificate, the certifier has to check one of 5 categories for females: not pregnant within last year; pregnant at the time of death; not pregnant, but pregnant within 42 days of death; not pregnant but pregnant 43 days to 1 year before death; and unknown if pregnant within last year. Has there been any quantification or general sense of what percentage of childbearing age females are certified with “unknown”? One concern I have coming from a medical examiner perspective is that we most often check that as we simple are often do not necessarily have that knowledge. Unless it is very obvious and known that a person was pregnant in the last year, most ME

ffices would not know as pregnancy history is not routinely screened for and gathered

during a death investigation. This probably wouldn’t have a large effect on pregnancy-related deaths, but pregnancy associated deaths could be underestimated as there could be medical examiner cases of suicides, accidents, etc where pregnancy status is just simply unknown. Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

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SLIDE 4 4. The MMRP identified challenges discussed that finalized vital statistics data is only made available on an annual basis, which prohibits ongoing case identification and review. Can someone discuss the process and timeline of how cases are identified? I have served

n other mortality boards in Coconino County and in other states before coming to

Coconino County, and it seemed like cases were identified and the review process started soon after death registration or death certification occurred. I’m wondering if there are capabilities to identify these cases in a more real-time sense. 5. When it comes to morbidity data, why are data available only delivery hospitalizations? Is this due to a statute or a different rule? Is there any sort of mechanism to get pregnancy or postpartum related ER visits or hospitalization data? 5. Roundtable Discussions Among Advisory Committee for Recommendation Development The Advisory Committee’s discussion was facilitated by Dave Nakashima and centered around four areas of focus; Data Collection Process, Committee Composition, Maternal Mortality Review Process, and Dissemination and Implementation Of MMRC Findings and Recommendations. Data Collection Process:

Include all recommendations from the ADHS meeting handout titled, Maternal Mortality

Review Process: Identified Challenges and Recommendations

Develop training for those entities and staff that records are being requested from

○ Understanding of what is being asked and statute requirements

Increase real time availability of records for pregnancy related deaths

○ Review as soon as possible it increase health outcomes in these hospitals

Build relationships across the state to decrease cycle time from record release

○ Increase MOU’s with hospital systems and all agencies involved

Reach out to the CDC for technical assistance

○ February 2019 CDC gave technical assistance to ADHS for the MMR process ○ ADHS was awarded the Maternal Mortality Review Grant that begins on September 30, 2019. This will increase staffing and give ADHS technical assistance from the CDC

Develop screening questions for Medical Examiners
Mortality data is pulled from death records from vital records.

○ Available on a yearly basis ○ Look at pulling data from HEI

Morbidity data is pulled from hospital discharge records

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SLIDE 5 ○ Available every 6 months

Look at Race/Ethnicity and mode of birth
Do not get specific death data from Indian Health Services

Committee Composition:

Include all recommendations from the ADHS meeting handout titled, Maternal Mortality

Review Process: Identified Challenges and Recommendations

Include key members of vital statistics and other record release departments on the

committee

Develop governing bylaws

○ Best practices that include items like membership, terms, and succession ○ Provide an orientation to train members and refresher, role and purpose , diversity on the team ○ Highlight our existent best practices to spread to other states (e.g. toxicology, law enforcement, etc.)

Reach out to CDC for technical assistance
Maternal Mortality Review is under the Child Fatality Review statute
Revise and possible have separate statute, clarifications
Strengthen behavioral health, social services departments, DCS representation
Increase attendance of the review committee – what can we do better

○ More formal commitment process MMR Committee Review Process:

Include all recommendations from the ADHS meeting handout titled, Maternal Mortality

Review Process: Identified Challenges and Recommendations

Develop governing bylaws

○ Best practices that include items like membership, terms, and succession ○ Draft clear definition of committee rules ○ Provide an orientation to train members and provide a refresher ○ Define role and purpose ○ Create greater diversity on the team ○ Highlight our existent best practices to spread to other states (e.g. toxicology, law enforcement, etc.)

Conduct environmental scan

○ What are the needs of committee/what works best for all Dissemination and Implementation of MMRC Findings and Recommendations: Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

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SLIDE 6

Include all recommendations from the ADHS meeting handout titled, Maternal Mortality

Review Process: Identified Challenges and Recommendations

Current Maternal Mortality Review Committee’s role is to review cases not do this

bigger systems work – possible changes ○ Change MMRC’s role and divide their time to 2/3rd review and 1/3rd systems change work

Continue with this Advisory Committee to meet twice a year
Create a Steering Committee or Stakeholders Committee to meet periodically

○ Engaging stakeholders and systems of care is more sustainable over time regardless of funding fluctuations

ADHS staff will be responsible for the majority of the follow through on these

recommendations 6. Review Timeline and Next Steps Dave Nakashima presented a draft of the Proposed Advisory Committee Timeline and facilitated

discussion. Patricia gave instructions on open meeting law requirements. After a facilitated

review and discussion of the timeline, the Advisory Committee decided on October 17, 2019 from 8:30 am – 12:00 pm and November 14, 2019 from 8:30 am – 12:00 pm for their third and fourth Advisory Committee Meetings. October 30, 2019 from 11:00 am – 1:00 pm was chosen for the Public Hearing Meeting. Advisory Committee members were encouraged to attend the Public Hearing Meeting for discussion with the public; however, a quorum does not have to be met. Madam Chair Patricia Tarango requested that the Advisory Committee make a motion regarding their recommendations and action steps, as well as for the acceptance of the proposed timeline.

Ms. Sandy Severson motioned to accept the recommendations proposed by the ADHS staff

(referencing the Maternal Mortality Review Process Identified Challenges and Recommendations document) with the inclusion of the recommendations presented during the meeting by the Advisory Committee members during the roundtable discussion. Ms. Mary Ellen Cunningham seconded the motion and the advisory committee voted and approved. Please refer to the meeting handout titled, Maternal Mortality Review Process: Identified Challenges and Recommendations for more information. Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

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SLIDE 7

Dr. Charlton Wilson motioned to accept the written proposed timeline with the addition of the

dates and times decided on above. Dr. Robert Johnson seconded the motion and the advisory committee voted and approved. More details are provided on the meeting presentation handout. 7. Call to the Public A call to the public was made. No public members addressed the Advisory Committee. 8. Meeting Adjourned The meeting was adjourned at 2:03 PM by Madam Chair Patricia Tarango. Madam Chair Patricia Tarango motioned to adjourn the meeting and Dr. Robert Johnson seconded the motion and the advisory committee voted and approved. Douglas A. Ducey | Governor Cara M. Christ, MD, MS | Director 150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

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SLIDE 8 Timeline for Draft Due Dates and Meetings Date Draft Due or Meeting Mon, September 16 12 pm - 2 pm Second Advisory Committee Meeting (Advisory Committee to develop recommendations) Tues, October 1 ADHS draft #1 due & sent to Advisory Committee Tues, October 15 Advisory Committee comments on draft #1 due to ADHS Thurs, October 17 8:30 am - 12 pm Third Advisory Committee Meeting (ADHS to bring consolidated Advisory Committee comments) Wed, October 30 11 am - 1 pm Public Hearing Meeting (ADHS to present on Advisory Committee process and recommendations) Mon, November 4 ADHS draft #2 due (incorporating public comments from the public hearing) & sent to Advisory Committee Tues, November 12 Advisory Committee comments on draft #2 due to ADHS Thurs, November 14 8:30 am - 12 pm Fourth Advisory Committee Meeting (ADHS to bring consolidated Advisory Committee comments) Fri, November 22 Final draft due (incorporating committee comments) & forward for internal review Tues, December 31 Final report submitted to legislative committees Updated 10/7/2019